Lung cancer is frequently advanced at diagnosis, and over 80% of lung cancer patients experience multiple symptoms, such as depression, anxiety, pain, fatigue, and breathlessness, which negatively impact their quality of life. Family caregivers of lung cancer patients also experience high rates of anxiety and depressive symptoms and poor quality-of-life outcomes. This application proposes a program of research and career training focused on improving patient-caregiver dyads'physical and psychological adjustment to lung cancer. The proposed research will further develop and test a novel, dyad-focused telephone symptom management (TSM) intervention with the potential to treat highly prevalent and disabling symptoms in advanced lung cancer patients and their caregivers. The intervention is a blend of evidence-based cognitive-behavioral and emotion- focused strategies that include instruction in relaxation, adaptive thinking and communication skills, and activity planning and pacing. While prior studies have primarily tested cognitive-behavioral interventions to improve patients'and couples'adjustment to early-stage cancer, TSM addresses advanced cancer patients'and caregivers'concerns and combines cognitive-behavioral and emotion-focused approaches. The proposed research includes two phases. In Phase 1, qualitative interviews will be conducted with advanced lung cancer patients and caregivers (N = 24 dyads) to ensure that the intervention is sensitive to the needs and preferences of the target population. The intervention will then be revised based on the qualitative findings. In Phase 2, advanced lung cancer patients who meet established clinical cutoffs for at least one of five symptoms (i.e., depressive symptoms, anxiety, pain, fatigue, or breathlessness) and their family caregivers (e.g., spouse, other relative) who meet clinical cutoffs for depressive symptoms or anxiety (N = 100 dyads) will be randomized to (1) five weekly phone sessions of TSM intervention tailored to patients'and caregivers'symptoms, or (2) five weekly phone sessions of an attention control condition that provides an overview of resources for psychosocial support and health information. Assessments will be administered at baseline and 2 and 6 weeks post-intervention. Brief symptom assessments will also be administered to patients and caregivers during each intervention or control session. Patient outcomes will include symptom control (i.e., depressive symptoms, anxiety, pain, fatigue, breathlessness, and overall symptom burden), functional status, quality of life, and quality of relationship with the caregiver. Caregiver outcomes will include depressive symptoms, anxiety, strain, quality of life, and quality of relationship with the patient. Patient and caregiver self- efficacy for symptom management also will be assessed as potential mediators of the effects of TSM on outcomes. The proposed research has the potential to provide valuable, new information that can aid in selecting strategies for helping advanced lung cancer patients and their family caregivers better manage symptoms. The career development plan includes training in the natural history and clinical aspects of lung cancer and theories and research methods for developing and evaluating technology-based interventions for cancer patient-caregiver dyads. Through a combination of mentored research, coursework, seminars, and directed learning experiences, the applicant will develop the necessary skills for building an independently funded program of research focused on improving patient-caregiver dyads'physical and psychological adjustment to cancer.

Public Health Relevance

Public Health Relevance: First, the award will produce a highly trained cancer control researcher with a focus on developing and evaluating technology-based interventions that can enhance patients'and family caregivers' physical and psychological adjustment to cancer. Second, the proposal will test a new and innovative intervention with the potential to improve health outcomes in distressed patient-caregiver dyads coping with advanced lung cancer, a population that has received relatively little attention in behavioral medicine research.